PubMed Health⌕ Search

Biomedical subjects

L E Mehl-Madrona

Publications and source records attributed to L E Mehl-Madrona.

5 recordsLinked to original sources
PubMed1999

Native American medicine in the treatment of chronic illness: developing an integrated program and evaluating its effectiveness.

Traditional Native American healing practices are increasingly sought after by Native Americans as well as non-Natives. A series of meetings between traditional Native American healers and the author resulted in dialogues on the Native American worldview and biomedicine. Recommendations arose for how Native American treatment should proceed in the modern world and how to effectively introduce interested non-Natives to Native American healing practices. An approach for bridging cultures to facilitate the interaction of non-Natives with traditional healers was developed. A total of 116 patients were treated by the author in conjunction with traditional Native American healers. More than 80% of patients showed significant, persistent benefits from a time-intensive treatment program. A comparison group consisting of patients from the author's emergency room practice had significantly lower rates of improvement. An intensive program inspired by Native American practices lasting 7 to 10 days can achieve both health benefits and improved cost-effectiveness in the treatment of chronic physical illness. The treatment philosophy underlying this approach is best described as a dynamic energy system. Within this theoretical framework, physical illness, which is viewed as simultaneously spiritual, mental, and physical, can be treated by counseling and ceremony. Due to the interaction and hierarchical nature of these levels, intervention at any one level affects the others.

Chronic Disease↗
PubMedDate not supplied

Frequent users of rural primary care: comparisons with randomly selected users.

BACKGROUND: Frequent users of primary care have not been adequately characterized. The unique characteristics of this population was sought--why they come so often, what their care costs, and whether psychosocial factors play a role in their high utilization of health care. METHODS: The billing system of a rural primary care clinic was used to find the frequency of visits for all patients attending the clinic for the previous 12 months. The 211 most frequent visitors were selected. A comparison group of 250 patients was drawn from the billing records using a random number generator. Charts were reviewed to compare diagnoses (by frequency), number of procedures, amount billed for care, amount received from those billings, number of psychotropic medications prescribed, and response to medication. A subgroup of each group was interviewed to confirm chart review findings and to inquire about personal reasons for coming to the clinic. RESULTS: Compared with patients who were random users, patients who were frequent users were more likely to come from the younger and older age groups, they averaged significantly more emergency department visits and visits to other specialists (P < 0.0001), and they had more mental health problems diagnosed (P < 0.01). Significantly more frequent users were insured by Medicaid and fewer were insured by Medicare. They had more detailed office visits and more laboratory tests. They received twice as much psychotherapy and had a higher percentage of problem-focused office visits. Chart audits and interviews of selected patients revealed that many nonmedical reasons were related to visits in addition to psychosocial stressors. CONCLUSIONS: Nonmedical factors are important among the most frequent users of a primary care clinic. Proposals to improve care for frequent users should consider the psychosocial needs of this population.

Adolescent↗
PubMedDate not supplied

Comparison of ketorolac-chlorpromazine with meperidine-promethazine for treatment of exacerbations of chronic pain.

BACKGROUND: The aim was to compare the efficacy and safety of a combination of intramuscular ketorolac and chlorpromazine for the treatment of acute exacerbations of chronic pain with the more commonly used regimen of intramuscular meperidine and promethazine. METHODS: Use-effective case series were drawn from a real-life, rural emergency department practice, in which 200 consecutive patients coming to a rural emergency department with acute exacerbations of chronic pain syndromes were assigned on an every-other basis in a single-blind fashion to one of the two treatment conditions. Patients were given intramuscular doses of either 60 mg of ketorolac plus 50 mg of chlorpromazine (75 mg of chlorpromazine for patients weighing more than 100 kg), or 50 mg of meperidine plus 25 mg of promethazine (50 mg of promethazine for patients weighing more than 75 kg); patients weighing more than 100 kg were given 1.5 doses. Patients older than 65 years or whose blood pressure at the time of injection was less than 110/70 mmHg were given half-doses. Patients could receive one additional half-dose injection if they had no results within 30 to 60 minutes after the first injection. Patients were assessed on self-report and on a verbal and visual analog scale of pain rating. Temperature, blood pressure, heart rate, and respirations were monitored every 15 minutes. RESULTS: Both regimens performed well, with more than 90 percent of patients reporting good or excellent improvement on acute exacerbations of chronic pain. Ketorolac-chlorpromazine offered significant advantages compared with meperidine-promethazine when patients rated their pain on a visual analog pain scale (P < 0.05) but not on a verbal scale. Adverse reactions were minimal and consisted of more respiratory tract depression with meperidine and more vertigo or dizziness with chlorpromazine. There was no difference in incidence of hypotension between the two groups. CONCLUSIONS: The combination of ketorolac and chlorpromazine is a safe and efficacious alternative to meperidine plus promethazine for the treatment of exacerbations of chronic pain in the rural emergency department setting.

Adolescent↗